HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �l$7 � Cy\ SCANNED Permit Number
BY
J c St. Lucie County RECEIVED
• - Building Permit Applicatio[FEB20)9
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division - - -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial :�s— Residential_
PERMITTYPE: CCA Cr_V, �S6Jm L�sxt `ca�Q
PROPOSED INPROVEMENT LOCATION:
Address:
Property
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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VCLctc
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Block No.
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I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ cS
. ✓indows/Doors
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
Name i C c gv . 'rx
CONTRACTOR:
Name: _�;
Company: _L�)M p
. T�C-5slU2Z�
AddressjQ?S � S OCeOn b-C.
City: Men_<zn e�eGoh State: _S-�J
Zip Code: 3Lt) S4-- Fax:
Phone No.
Address: 3
61 .1'
City: 1 r
Zip Code: S�
Phone No d 1bPs
Fax: 5�6
Iran(Gq�
State:
- `),35 -H u 1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail n m
State or County License C G C_ 1SZ4"1
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it value of Construction is �,ZSUU or more, a RECORDED Notice of commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
City:
Zip::
FEE SIMPLE TITLE HOLDER:
Address:
City:
Zip: Phone:
NOT Appllcame MORTGAGE COMPANY: J/ Not Applicable
Address:
City: State:
Zip: Phone:
Applicable I BONDING COMPANY:
Address:
Zip:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify,that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si"
gnblre of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFS�, 4 G _ [,,Gte
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COUNTYOF 4- \ vc e
The forgoing instru ent was acknowledged b
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The forgoing. instrument was acknowledged before
thisjdayof S 20X5 b
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this}dayof�j 2015 by
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Name of person making statement.
Name of person making statement.
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Personally Known G11", OR Produced Iden
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Personally Known t/ OR Produced Identificati
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Type of Identification
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(Signat o otary PC-0
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(Signature of No tyy Public -State of Florida)
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Commission No 2S3 ( )'-;o.�•�s,:,`
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Commission No. 'I (Seal)
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REVIEW REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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